Rf90 Use of Impella in Off Pump Myocardial Revascularization With Ef Below 30 %.

Abstract

Background and Aim: Patients undergoing coronary surgery are changed in the last years becoming a challenge for the cardiac surgeon not only for the quality of the coronary artery involved in the disease but mainly for the quality of patients in terms of low ejection fraction, elderly, COPD, kidney failure, Diabetes. Beating heart myocardial revascularization is a well established surgical technique but in case of very low EF (below 30%) there is a particular high surgical risk of conversion to on-pump surgery. The recently developed of Impella device (Abiomed, Danvers, MA) represent a compromise between circulatory support and limited invasiveness. Methods: Six patients, male, admitted for acute coronary syndrome with three vessels CAD with low ejection fraction were operated in our department. Impella Recover LP 5.0 device was inserted via surgical exposure of the right femoral artery in one case and an Impella recover LP 4,5 via percutaneous insertion of the femoral artery in five cases. Results: The myocardial revascularization was performed using a complete arterial revascularization. The device was left in for 48 Hours after the operation. All patients were discharged home after 9-10 days after admission and a follow up echocardiography performed six month up to two year after the operation showed an increase of the ejection fraction up to 40-45%. Conclusions: Use of the Impella Recover device for patients undergoing off pump CABG is feasible and safe, and appears a promising strategy to improve short- and long-term outcomes.